A Claims-Based Algorithm to Identify Inadequate Response to Immunomodulatory Therapies Among Patients with Selected Autoimmune Diseases


Grabner M1, Hunter T2, Teng CC1, Isenberg K3, Burge RT2, Birt J2, Naegeli A2, Shan M4, Curtis JR5
1HealthCore, Inc., Wilmington, DE, USA, 2Eli Lilly and Company, Indianapolis, IN, USA, 3Anthem Inc., Indianapolis, IN, USA, 4Eli Lilly and Company, Indianapolis, USA; Division of Pharmaceutical Sciences, University of Cincinnati, Indianapolis, IN, USA, 5University of Alabama at Birmingham, Birmingham, AL, USA


To evaluate a claims-based algorithm initially validated for rheumatoid arthritis to identify inadequate response (IR) to advanced therapy (AT) with immunomodulators among patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), ulcerative colitis (UC), Crohn’s disease (CD), lupus (SLE), and psoriasis (PsO).


This retrospective cohort study used data from the HealthCore Integrated Research Database. Adult patients with AS, PsA, UC, CD, SLE, and PsO who initiated AT (TNFi, non-TNFi biologics, other pharmacotherapies) from 7/1/2016-8/31/2018 and had continuous enrollment ≥6 months before and ≥12 months after index date (first AT claim date) were included. The algorithm criteria used healthcare resource utilization proxies associated with inadequate clinical response. Baseline characteristics associated with IR were identified via logistic regressions.


Patients were identified as having IR to their index AT if during the 12months after index date they had ≥1 of the following: low adherence (proportion of days covered <80%), switched/added a new AT, added a new conventional immunomodulator, increased dose/frequency of AT, had >1 glucocorticoid injection/infusion, addition/dose increase of oral glucocorticoids, or use of new pain medication; additional disease-specific criteria included: (PsO/PsA) use of a new topical treatment, actinotherapy, or retinoids; (SLE) intravenous immunoglobulin; (AS) spinal procedures; (UC/CD) GI surgery. Sample sizes and IR frequencies were: AS:N=646, 69%; PsA:N=1,433, 77%; UC:N=1,692, 63%; CD:N=2,437, 62%; SLE:N=448, 84%; PsO:N=4,952, 70%. Across all diseases, IR was mostly driven by low adherence. Certain baseline patient characteristics (e.g. higher age, conventional immunomodulator usage) were associated with IR.


Using adaptations to a validated claims algorithm that proxies for inadequate clinical response, the proportions of AS, PsA, UC, CD, SLE, and PsO patients with IR ranged from 62-84%. Health plan claims data appear useful to classify IR in these patients and additional research should be done to further validate the algorithm adaptations in a clinical setting.

Conference/Value in Health Info

2021-05, ISPOR 2021, Montreal, Canada

Value in Health, Volume 24, Issue 5, S1 (May 2021)




Patient-Centered Research

Topic Subcategory

Adherence, Persistence, & Compliance


Gastrointestinal Disorders, Musculoskeletal Disorders, Systemic Disorders/Conditions

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